Provider Demographics
NPI:1740513928
Name:TRENTON MEDICAL CENTER INC
Entity type:Organization
Organization Name:TRENTON MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:REMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-454-0698
Mailing Address - Street 1:23476 NW 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-0673
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:386-454-0690
Practice Address - Street 1:200 SW 62ND BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6030
Practice Address - Country:US
Practice Address - Phone:352-376-8211
Practice Address - Fax:352-373-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-07
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029506013Medicaid
FL77513AOtherFIRST COAST PTAN
FL029506013Medicaid